The LTCi Claims Process in Five Steps

STEP 1:

Making Initial Contact

Often the agent is the first point of contact.

• If the insured contacts you, notify the claims department as soon as possible
• The insured also can contact the claims department directly. The appropriate phone number is listed in the policy

STEP 2:

Gathering Information

A claims representative will:

• Talk with the insured to gather more information
• Send the insured a claim form
• Provide a list of documentation needed (i.e. medical records, provider bills)

STEP 3:

Explaining Policy Benefits

A claims representative will explain the benefits of the insured’s specific policy. This may include:

• Elimination period
• Care coordination services
• Payment of benefits
• Waiver of premium

STEP 4:

Determining Benefit Eligibility

• It takes approximately 10 business days to review a claim and determine benefit eligibility
• Claims notifies the insured or his or her representative when eligibility is confirmed

STEP 5:

Paying the Claim

• It takes approximately 10 business days to approve an expense and issue a check
• Payment is sent to the insured, to his or her representative or to an LTC service provider